Physician-assisted dying clearly has become the bioethical issue of the 1990s. Recent right-to-die ballot measures were narrowly defeated in two states. A third will be decided in Oregon this November. Michigan, Washington and New York all currently await the outcome of major, related court cases.
Despite the publicity accorded Dr. Jack Kevorkian and the best-selling books Final Exit and How We Die, physician-aided dying has reached this level of national debate not because of the notoriety of some of its proponents, but because of the ever-increasing sophistication of high-tech medicine and the ability of the medical community to keep the human body functioning long past its "natural" point of departure, or even its owner's wishes. As with so many modern issues, the debate about physician-aided dying has arisen because we, as a culture, have learned so well how to answer the question, "Can we do this?" and have never learned how to answer so easily the question, "Should we do this?"
For most of recorded history, physician-aided dying, although surely practiced, has not been an issue. Most people died of their first major illness, and life expectancies generally were short. Noted British physician and journalist Jonathan Miller estimates that not until the beginning of the 20th century did medicine do anything to prolong the average life, and it probably killed as many people as it cured.
The discovery and use of antibiotics marked the first great change in this situation, followed by the beginning of artificial life-support systems: respirators, feeding tubes, artificial nutrition, hydration and even artificial organs. With this constatly accelerating technological change, life could be prolonged, expanded and even saved -- or so it seemed.
But with the new technology, as we have learned all too well in every scientific field, came new questions. For example, what do we mean when we say "life"? Do we mean the continued functioning of the body? Of the brain? Or do we mean the continued experience of the human being? And if so, does that experience have to have quality as well as quantity?
Beginning in the 1970s, groups began to form to assert the right of physician-aided dying and to challenge legal restraints to it in the courts. First came the case of Karen Ann Quinlan, kept alive artificially until her family went to court and sued for the right to terminate life support for a brain-dead patient. (Quinlan's parents won the right to remove a respirator from her bedside in 1976; she died nine years later.) Then, in 1990, the case of Nancy Cruzan established the legal right of an individual to determine whether or not he or she would want to be kept alive artificially. Following the Supreme Court decision in the Cruzan case, Congress passed the Federal Patient Self-Determination Act, which clearly established the right of every patient to reject life-sustaining treatment.
There can be little doubt that these legal confrontations came in direct response to the changing landscape of medical science. Before the advent of machinery to artificially prolong life, the Quinlan and Cruzan cases would not have been possible. But at the same time, we witnessed an unmistakable response to the ever-worsening ways in which people died. The 1980s saw a dramatic rise in the number of reported cases of euthanasia and mercy killing. Of the 519 reported cases of assisted death between 1920 and 1993, 476 occurred after 1979. More than 91 percent of the reported cases of euthanasia and mercy killing in the past eight decades have been reported in the last 14 years. There can be no more telling statistic to indicate the fear of modern ways of dying than this. For many people, the suffering and excruciating pain of dying in America at the end of the 20th century are far, far more frightening than death itself.
There is every indication that the same response to the horrors of uncontrolled technology and modern disease has led many doctors to the conclusion that physician-aided dying is a grim necessity of our world. …